Provider Demographics
NPI:1063853208
Name:CZERWONY, SEBASTIAN (RPH)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:CZERWONY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 CHURCH ST N
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4300
Mailing Address - Country:US
Mailing Address - Phone:704-262-1054
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH ST N
Practice Address - Street 2:SUITE 308
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4300
Practice Address - Country:US
Practice Address - Phone:704-262-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist